{"id":1518,"date":"2018-06-06T19:11:19","date_gmt":"2018-06-06T10:11:19","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=1518"},"modified":"2018-06-06T19:11:19","modified_gmt":"2018-06-06T10:11:19","slug":"%e6%88%90%e4%ba%ba%e3%81%ae%e6%80%a5%e6%80%a7%e8%85%8e%e7%9b%82%e8%85%8e%e7%82%8e","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=1518","title":{"rendered":"\u6210\u4eba\u306e\u6025\u6027\u814e\u76c2\u814e\u708e"},"content":{"rendered":"<p>-\u6587\u732e\u540d-<br \/>\nJames R. Johnson, M.D., and Thomas A. Russo, M.D., C.M. \u3000Acute Pyelonephritis in Adults<br \/>\nN Engl J Med 2018;378:48-59.<\/p>\n<p>-\u8981\u7d04-<br \/>\n\u3010Pathogen\u3011<br \/>\n\u30fb\u82e5\u5e74\u5065\u5eb7\u5973\u6027\u306e\u8d77\u708e\u83cc\u306e90%\u4ee5\u4e0a\u306fE.coli<br \/>\n\u30fb\u7537\u6027\u3084\u8001\u4eba\u5973\u6027\u3001\u65bd\u8a2d\u5165\u9662\u60a3\u8005\u306e\u8d77\u708e\u83cc\u306f\u5f31\u6bd2E.coli\u682a\u3001\u30b0\u30e9\u30e0\u9670\u6027\u83cc\u3001\u30b0\u30e9\u30e0\u967d\u6027\u83cc\u3001\u30ab\u30f3\u30b8\u30c0\u304c\u4e00\u822c\u7684<br \/>\n\u30fbsequence type\u304cST131\u3067\u3042\u308b\u8010\u6027E.coli clone\u304c\u5e83\u307e\u3063\u3066\u3044\u308b<br \/>\n\u3010Strategies and Evidence\u3011<br \/>\nDiagnosis<br \/>\n\u30fb\u814e\u76c2\u814e\u708e\u306e\u8a3a\u65ad\u306f\u300c\u5074\u8179\u90e8\u75db\u307e\u305f\u306f\u3001\u5074\u8179\u90e8\u306e\u5727\u75db\u304c\u3042\u308a\u3001\u7d30\u83cc\u5c3f\u304b\u81bf\u5c3f\u300d\u304c\u5b58\u5728\u3059\u308b\u5834\u5408\u306b\u63a8\u6e2c\u3055\u308c\u3001\u78ba\u5b9a\u8a3a\u65ad\u306f\u5c3f\u57f9\u990a\u306710,000\/mm3\u4ee5\u4e0a\u306e\u30b3\u30ed\u30cb\u30fc\u306e\u5b58\u5728\u3067\u3042\u308b<br \/>\n\u30fb\u6297\u83cc\u85ac\u6cbb\u7642\u3092\u53d7\u3051\u3066\u3044\u305f\u308a\u3001\u5c3f\u304c\u6975\u5ea6\u306b\u9178\u6027\u3001\u3042\u308b\u3044\u306f\u5c3f\u8def\u9589\u585e\u304c\u3042\u308c\u3070\u30b3\u30ed\u30cb\u30fc\u6570\u304c\u5c11\u306a\u3044\u3053\u3068\u3082\u3042\u308b<br \/>\n\u30fb\u5178\u578b\u7684\u306b\u306f\u5168\u8eab\u708e\u75c7\uff08\u767a\u71b1\u3001\u60aa\u5bd2\u3001\u5026\u6020\u611f\uff09\u3068\u8180\u80f1\u708e\u75c7\uff08\u983b\u5c3f\u3001\u5c3f\u610f\u5207\u8feb\u3001\u6392\u5c3f\u969c\u5bb3\uff09\u304c\u3042\u308b\u304c\u3001\u8a3a\u65ad\u57fa\u6e96\u306e\u30b3\u30f3\u30bb\u30f3\u30b5\u30b9\u306f\u306a\u3044\u3002\u60a3\u8005\u306e20%\u306b\u306f\u8180\u80f1\u75c7\u72b6\u304c\u306a\u304f\u3001\u767a\u71b1\u304c\u306a\u3044<br \/>\n\u30fb\u6557\u8840\u75c7\u3001\u6557\u8840\u75c7\u6027\u30b7\u30e7\u30c3\u30af\u3001\u7d50\u77f3\u3001\u5c3fpH\u304c7.0\u4ee5\u4e0a\u3001\u65b0\u305f\u306bGFR\uff1c40ml\/\u5206\u306b\u306a\u3063\u305f\u5834\u5408\u306f\u3001\u9589\u585e\u304c\u793a\u5506\u3057\u3066\u3044\u308b\u305f\u3081\u753b\u50cf\u8a3a\u65ad\uff08\u8d85\u97f3\u6ce2\u3001CT\uff09\u3092\u884c\u3046<br \/>\nTreatment<br \/>\n\u91cd\u75c7\u5ea6\u3001\u5171\u5b58\u3059\u308b\u75c5\u72b6\u3001\u5fc3\u7406\u793e\u4f1a\u7684\u72b6\u614b\u306b\u3088\u3063\u3066\u3001\u60a3\u8005\u306b\u306f\u4ee5\u4e0b\u306e3\u3064\u306edisposition\u3092\u884c\u3046<br \/>\n\u2460\u5e30\u5b85\uff1a\u8f38\u6db2\u30dc\u30fc\u30e9\u30b9\u3084\u6301\u7d9a\u6027\u5e83\u57df\u6297\u83cc\u85ac\u6ce8\u5c04\u5f8c\u3002\u8efd\u75c7\u3067\u5614\u6c17\u304c\u5c11\u306a\u304f\u3001\u5b89\u5b9a\u3057\u3001\u5fc3\u7406\u793e\u4f1a\u7684\u72b6\u6cc1\u304c\u8a31\u3059\u3068\u304d<br \/>\n\u2461\u51e6\u7f6e\u5ba4\u3067\u89b3\u5bdf\uff1a\u5185\u670d\u3001\u98f2\u6c34\u304c\u51fa\u6765\u305a\u3001\u8131\u6c34\u304c\u3042\u308a\u3001\u5e30\u5b85\u3059\u308b\u306b\u306f\u72b6\u614b\u304c\u60aa\u3044\u3068\u304d<br \/>\n\u2462\u5373\u6642\u5165\u9662\uff1a\u5168\u8eab\u72b6\u614b\u304c\u60aa\u3044\u3068\u304d<br \/>\n\u6cbb\u7642\u306e3\u672c\u67f1\u306f\u5bfe\u75c7\u7642\u6cd5\u3001\u6297\u83cc\u85ac\u7642\u6cd5\u3001\u767a\u751f\u6e90\u306e\u7ba1\u7406\u3067\u3042\u308b<br \/>\nSupportive care\uff08\u5bfe\u75c7\u7642\u6cd5\uff09<br \/>\n\u30fb\u8f38\u6db2\u3067\u5026\u6020\u611f\u3001\u5614\u6c17\u5614\u5410\u3092\u8efd\u6e1b\u3067\u304d\u308b\u305f\u3081\u30013\u6642\u9593\u3067\u30ea\u30f3\u30b2\u30eb\u309230ml\/kg\u6295\u4e0e\u3059\u308b\u3002\u5fc5\u8981\u306b\u5fdc\u3058\u3066\u3001\u93ae\u75db\u85ac\u3001\u89e3\u71b1\u85ac\u3001\u5236\u5410\u5264\u3092\u4f7f\u7528\u3059\u308b<br \/>\nInitial Antimicrobial Therapy\uff08\u6297\u83cc\u85ac\u7642\u6cd5\uff09<br \/>\n\u30fb\u30d5\u30eb\u30aa\u30ed\u30ad\u30ce\u30ed\u30f3\u3001ST\u5408\u5264\u306f\u611f\u53d7\u6027\u304c\u3042\u308c\u3070\u975e\u5e38\u306b\u6709\u52b9\u3067\u3001\u5c3f\u4e2d\u3001\u814e\u7d44\u7e54\u3067\u3082\u9ad8\u6fc3\u5ea6\u306b\u306a\u308a\u6210\u529f\u738790%\u4ee5\u4e0a\u3067\u3042\u308b<br \/>\n\u30fbST\u5408\u5264\u306b\u5bfe\u3059\u308bE.coli\u306e\u8010\u6027\u7387\u306f10%\u3092\u8d85\u3048\u308b\u3002IDSA\u3067\u306f\u30d5\u30eb\u30aa\u30ed\u30ad\u30ce\u30ed\u30f3\u306e\u8010\u6027\u7387\u304c10%\u4ee5\u4e0b\u306a\u3089\u3001\u7d4c\u9a13\u7684\u6cbb\u7642\u3092\u63a8\u5968\u3057\u3066\u3044\u308b<br \/>\n\u30fb\u5065\u5eb7\u5973\u6027\u3067\u8efd\u75c7\u814e\u76c2\u814e\u708e\u3067\u306f\u3001E.coli\u306b\u5bfe\u3057\u3066\u8010\u6027\u7387\u304c15%\u3067\u3082\u4f7f\u7528\u3057\u3066\u826f\u3044\u304c\u3001\u91cd\u75c7\u60a3\u8005\u3067\u306f\u7518\u304f\u3001\u8010\u6027\u7387\u304c20%\u4ee5\u4e0a\u306e\u5834\u5408\u306f\u3001\u6301\u7d9a\u6027\u306e\u88dc\u52a9\u85ac\uff08CTRX\u3001GM\u3001amikacin\u7b49\uff09\u3092\u6295\u4e0e\u3059\u3079\u304d\u3067\u3042\u308b<br \/>\n\u30fb\u63a8\u5968\u6295\u4e0e\u671f\u9593\uff1a\u5185\u670d\u306f\u30ec\u30dc\u30d5\u30ed\u30ad\u30b5\u30b7\u30f35\u65e5\u3001ST\u5408\u5264\u30fb\u03b2\u30e9\u30af\u30bf\u30e010-14\u65e5\u3001\u9759\u6ce8\u85ac\u306f7-14\u65e5<br \/>\n\u30fb\u81e8\u5e8a\u75c7\u72b6\u306f\u5f90\u3005\u306b\u6539\u5584\u3059\u308b\u304c\u3001\u5bdb\u89e3\u306b\u306f\u6700\u59275\u65e5\u3050\u3089\u3044\u304b\u304b\u308b\u3053\u3068\u3082\u3042\u308b\u3002\u6297\u83cc\u85ac\u6295\u4e0e\u5f8c1-2\u65e5\u3067\u6539\u5584\u3057\u306a\u3044\u5834\u5408\u306b\u306f\u3001\u9589\u585e\uff08\u7d50\u77f3\u3001\u4e3b\u8981\u3001\u938c\u72b6\u8d64\u8840\u7403\u75c7\uff09\u3001DM\u3001\u814e\u30fb\u508d\u814e\u81bf\u760d\u3001\u6c17\u816b\u6027\u814e\u76c2\u814e\u708e\u306a\u3069\u306e\u5408\u4f75\u304c\u61f8\u5ff5\u3055\u308c\u308b\u305f\u3081\u306b\u3001\u5c3f\u57f9\u990a\u3001\u304a\u3088\u3073\u753b\u50cf\u306b\u3088\u308b\u7cbe\u67fb\u304c\u5fc5\u8981\u3067\u3042\u308b\u3002\u5916\u6765\u60a3\u8005\u3067\u3042\u308c\u3070\u3088\u308a\u5e83\u57df\u306e\u6297\u83cc\u85ac\u306b\u5909\u66f4\u3059\u308b\u3002<br \/>\nSource Control\uff08\u767a\u751f\u6e90\u306e\u7ba1\u7406\uff09<br \/>\n\u30fb\u30a8\u30b3\u30fc\u306f\u6c34\u814e\u75c7\u8a3a\u65ad\u306b\u306fCT\u3088\u308a\u611f\u5ea6\u304c\u9ad8\u3044<br \/>\n\u30fb\u9020\u5f71CT\u306f\u81bf\u760d\u3001\u81bf\u760d\u3001\u708e\u75c7\u3001\u30ac\u30b9\u5f62\u6210\u306b\u306f\u611f\u5ea6\u304c\u9ad8\u3044<br \/>\n\u30fb\u6c34\u814e\u75c7\u306e\u6cbb\u7642\u306f\u3001\u7d4c\u76ae\u7684\u3042\u308b\u3044\u306f\u7d4c\u5c3f\u9053\u7684\u30c9\u30ec\u30ca\u30fc\u30b8\u304c\u5fc5\u8981\u3067\u3042\u308b<br \/>\n\u30fb\u6c17\u816b\u6027\u814e\u76c2\u814e\u708e\u306f\u3001\u901a\u5e38\u3001\u90e8\u5206\u7684\u3042\u308b\u3044\u306f\u5168\u814e\u5207\u9664\u304c\u5fc5\u8981\u3067\u3042\u308b<br \/>\nSpecial Populations<br \/>\n\u30fb\u598a\u5a20\u4e2d\u306e\u814e\u76c2\u814e\u708e\u306f\u6025\u901f\u306b\u9032\u884c\u3057\u3001\u6bcd\u4f53\u3068\u80ce\u5150\u306e\u751f\u547d\u3092\u8105\u304b\u3059\u305f\u3081\u3001\u598a\u5a20\u7b2c3\u671f\u3067\u306f\u5165\u9662\u3057\u3001\u9759\u8108\u5185\u6295\u4e0e\u3092\u884c\u3046<br \/>\n\u30fb\u80ce\u5150\u6bd2\u6027\u306f\u30a2\u30df\u30ce\u30b0\u30ea\u30b3\u30b7\u30c9\uff08\u598a\u5a20\u7b2c1\u671f\uff09\u3001ST\u5408\u5264\uff08\u5206\u5a29\u8fd1\u304f\uff09\u3001\u30d5\u30eb\u30aa\u30ed\u30ad\u30ce\u30ed\u30f3\uff08\u5168\u598a\u5a20\u671f\u9593\uff09\u3067\u3042\u308b<br \/>\n\u30fb\u814e\u79fb\u690d\u60a3\u8005\u306e\u814e\u76c2\u814e\u708e\u306f\u79fb\u690d\u4e0d\u5168\u306b\u7e4b\u304c\u308b\u3053\u3068\u304c\u3042\u308b\u305f\u3081\u6ce8\u610f\u304c\u5fc5\u8981\u3067\u3042\u308b<br \/>\n\u3010Guidelines\u3011<br \/>\n\u30fb\u5973\u6027\u306e\u8907\u96d1\u751f\u814e\u76c2\u814e\u708e\u306e\u307f\u306b\u5bfe\u5fdc\u3057\u3066\u3044\u308b<br \/>\n\u30fb\u5c3f\u57f9\u990a\u304c\u63a8\u5968\u3055\u308c\u308b<br \/>\n\u30fb\u7d4c\u53e3\u6297\u83cc\u85ac\u306b\u5bfe\u3059\u308b\u8010\u6027\u7387\u304c10%\u3092\u8d85\u3048\u308b\u5834\u5408\u306f\u3001\u30a2\u30df\u30ce\u30b0\u30ea\u30b3\u30b7\u30c9\u3042\u308b\u3044\u306f\u30bb\u30d5\u30c8\u30ea\u30a2\u30ad\u30bd\u30f3\u306e\u521d\u671f\u88dc\u52a9\u91cf\u3068\u6295\u4e0e\u3059\u3079\u304d\u3067\u3042\u308b<br \/>\n<a href=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/06\/\uff2a\uff2320180606\u5c3e\u5d0e.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-1519\" src=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/06\/\uff2a\uff2320180606\u5c3e\u5d0e.png\" alt=\"\uff2a\uff2320180606\u5c3e\u5d0e\" width=\"575\" height=\"261\" srcset=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/06\/\uff2a\uff2320180606\u5c3e\u5d0e.png 575w, https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/06\/\uff2a\uff2320180606\u5c3e\u5d0e-300x136.png 300w\" sizes=\"auto, (max-width: 575px) 100vw, 575px\" \/><\/a><\/p>\n<p><a href=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/06\/\uff2a\uff2320180606\u5c3e\u5d0e2.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-large wp-image-1520\" src=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/06\/\uff2a\uff2320180606\u5c3e\u5d0e2.png\" alt=\"\uff2a\uff2320180606\u5c3e\u5d0e2\" width=\"640\" height=\"518\" srcset=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/06\/\uff2a\uff2320180606\u5c3e\u5d0e2.png 672w, https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/06\/\uff2a\uff2320180606\u5c3e\u5d0e2-300x243.png 300w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><\/a><\/p>\n<p>\u3010\u958b\u50ac\u65e5\u30112018\u5e746\u67086\u65e5\uff08\u6c34\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"<p>-\u6587\u732e\u540d- James R. Johnson, M.D., and Thomas A. Russo, M.D., C.M. \u3000Acute Pyelonephritis in Adults N Engl J Med 201 &hellip; <a href=\"https:\/\/www.hcfm.jp\/journal\/?p=1518\" class=\"more-link\">\u7d9a\u304d\u3092\u8aad\u3080 <span class=\"screen-reader-text\">\u6210\u4eba\u306e\u6025\u6027\u814e\u76c2\u814e\u708e<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17],"tags":[],"class_list":["post-1518","post","type-post","status-publish","format-standard","hentry","category-17"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/1518","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1518"}],"version-history":[{"count":2,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/1518\/revisions"}],"predecessor-version":[{"id":1522,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/1518\/revisions\/1522"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1518"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1518"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1518"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}